Teammate Open Enrollment 2021
CalPERS Health Plans Benefit Comparison — Basic Plans, Continued For more details about the benefits provided by a specific plan, refer to that plan’s Evidence of Coverage (EOC) booklet. CalPERS Health Plan Benefit Comparison— Medicare Plans
For more details about the benefits provided by a specific plan, refer to that plan’s Evidence of Coverage (EOC) booklet.
Medicare Plans
CCPOA Medicare Supplement (Association Plan)
Kaiser Permanente Senior Advantage
Anthem Medicare Preferred (PPO)
Sharp Direct Advantage (HMO)
UnitedHealthcare Group Medicare Advantage (PPO)
BENEFITS
Calendar Year Deductible
Individual
N/A N/A
N/A N/A
N/A N/A
N/A N/A
N/A N/A
Family
Maximum Calendar Year Copay or Co-insurance (excluding pharmacy) Individual $1,500 (copay) $1,500 (copay/co-insurance)
$1,500 (copay/co-insurance)
$1,500 (copay)
$1,500 (copay)
$4,500 (3 or more)
Family
$3,000 (copay)
N/A
N/A
N/A
Hospital (including Mental Health and Substance Abuse) Inpatient No Charge
No Charge
No Charge
No Charge
$100/admission
Outpatient Facility/ Surgery Services
$10
No Charge
No Charge
No Charge
No Charge
Skilled Nursing Facility (up to 100 days/benefit period) No Charge
No Charge
No Charge
No Charge
No Charge
Home Health Services
$15/visit (up to 100 visits per calendar year)
No Charge
No Charge
No Charge
No Charge
Hospice
No Charge
No Charge
No Charge
No Charge
No Charge
24 | 2021 Health Benefit Summary
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